Glucagon-Like Peptide-1 Receptor Agonists in Post-bariatric Surgery Patients: A Systematic Review and Meta-analysis

Background

A significant number of patients face the issue of weight gain (WG) or inadequate weight loss (IWL) post-bariatric surgery for obesity. Several studies have been published evaluating the role of glucagon-like peptide-1 receptor agonists (GLP1RA) for weight loss post-bariatric surgery. However, no systematic review and meta-analysis (SRM) till date has evaluated the efficacy, safety and tolerability of GLP1RA in this clinical scenario. Hence, this SRM aimed to address this knowledge gap.

Methods

Databases were searched for randomized controlled trials (RCTs), case–control, cohort and observational studies involving use of GLP1RA in the intervention arm post-bariatric surgery. Primary outcome was weight loss post at least 3 months of therapy. Secondary outcomes were evaluation of body composition parameters, total adverse events (TAEs) and severe adverse events (SAEs).

Results

From initially screened 1759 articles, 8 studies (557 individuals) were analysed. Compared to placebo, patients receiving liraglutide had significantly greater weight loss after 6-month therapy [MD − 6.0 kg (95% CI, − 8.66 to − 3.33); P < 0.001; I² = 79%]. Compared to liraglutide, semaglutide had significantly greater percent reduction in body weight after 6-month [MD − 2.57% (95% CI, − 3.91 to − 1.23); P < 0.001; I² = 0%] and 12-month [MD − 4.15% (95% CI, − 6.96 to − 1.34); P = 0.004] therapy. In study by Murvelashvili et al. (2023), after 12-month therapy, semaglutide had significantly higher rates of achieving > 15% [OR 2.15 (95% CI, 1.07–4.33); P = 0.03; n = 207] and > 10% [OR 2.10 (95% CI, 1.19–3.71); P = 0.01; n = 207] weight loss. A significant decrease in fat mass [MD − 4.78 kg (95% CI, − 7.11 to − 2.45); P < 0.001], lean mass [MD − 3.01 kg (95% CI, − 4.80 to − 1.22); P = 0.001] and whole-body bone mineral density [MD − 0.02 kg/m² (95% CI, − 0.04 to − 0.00); P = 0.03] was noted with liraglutide.

Conclusion

Current data is encouraging regarding use of GLP1RAs for managing WG or IWL post-bariatric surgery. Deterioration of bone health and muscle mass remains a concern needing further evaluation.

Trial Registration

The predefined protocol has been registered in PROSPERO having registration number of CRD42023473991.

Graphical Abstract